Subscribe to RSS
DOI: 10.1055/s-0040-1718876
Antibiotic Timing in Previable Prelabor Rupture of Membranes Less Than 24 Weeks of Gestation

Abstract
Objective This study aimed to compare neonatal and maternal outcomes between immediate and delayed prophylactic antibiotic administration after previable prelabor premature rupture of membranes (PROM) less than 24 weeks of gestation.
Study Design Retrospective cohort study of singleton pregnancies with PROM between 160/7 and 236/7 weeks of gestational age conducted at a single tertiary care referral center between June 2011 and December 2015. Patients with multiple gestations, fetal anomalies, those who elected augmentation, or with a contradiction to expectant management, such as suspected intra-amniotic infection or stillbirth, were excluded from the study. We compared pregnancy characteristics, maternal complications, and neonatal outcomes between women who received a course of antibiotics within 24 hours of PROM and women who received antibiotics after 24 hours of PROM. The primary outcome was neonatal survival to hospital discharge. Secondary outcomes included gestational age at delivery, time from PROM to delivery, neonatal birth weight, days in the neonatal intensive care unit (NICU), composite adverse neonatal outcomes, and maternal morbidity.
Results Ninety-four women met inclusion criteria, 57 (61%) received antibiotics within 24 hours of PROM and 37 (39%) received antibiotics 24 hours after PROM. Baseline maternal characteristics were similar in both groups. The mean gestational age at PROM was similar between groups at 20.8 ± 2.3 weeks in the immediate antibiotics group and 20.6 ± 2.1 weeks in the delayed antibiotics group (p = 0.48). Compared with delayed antibiotic administration, immediate antibiotic administration was not associated with a significant difference in latency time from PROM to delivery, rate of stillbirth, days in an ICU, or adverse neonatal outcomes. Maternal outcomes also did not differ significantly between groups. Neonatal birth weight was lower in the immediate antibiotics group (p = 0.012).
Conclusion Our data suggest that there is no maternal or neonatal benefit to immediate administration of latency antibiotics compared with delayed administration.
Key Points
-
Adverse neonatal outcomes did not differ based on timing of latency antibiotics for previable PROM.
-
Maternal outcomes did not differ based on timing of latency antibiotics for previable PROM.
-
Neonatal birth weight was lower in infants that received immediate antibiotics after previable PROM.
Publication History
Received: 28 March 2020
Accepted: 16 September 2020
Article published online:
22 October 2020
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Margato MF, Martins GLP, Passini Júnior R, Nomura ML. Previable preterm rupture of membranes: gestational and neonatal outcomes. Arch Gynecol Obstet 2012; 285 (06) 1529-1534
- 2 Sim WH, Araujo Júnior E, Da Silva Costa F, Sheehan PM. Maternal and neonatal outcomes following expectant management of preterm prelabour rupture of membranes before viability. J Perinat Med 2017; 45 (01) 29-44
- 3 Hutzal CE, Boyle EM, Kenyon SL. et al. Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a metaanalysis. Am J Obstet Gynecol 2008; 199 (06) 620.e1-620.e8
- 4 Kiver V, Boos V, Thomas A, Henrich W, Weichert A. Perinatal outcomes after previable preterm premature rupture of membranes before 24 weeks of gestation. J Perinat Med 2018; 46 (05) 555-565
- 5 Xiao ZH, André P, Lacaze-Masmonteil T, Audibert F, Zupan V, Dehan M. Outcome of premature infants delivered after prolonged premature rupture of membranes before 25 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 2000; 90 (01) 67-71
- 6 Morales WJ, Talley T. Premature rupture of membranes at < 25 weeks: a management dilemma. Am J Obstet Gynecol 1993; 168 (02) 503-507
- 7 Miyazaki K, Furuhashi M, Yoshida K, Ishikawa K. Aggressive intervention of previable preterm premature rupture of membranes. Acta Obstet Gynecol Scand 2012; 91 (08) 923-929
- 8 Seelbach-Goebel B. Antibiotic therapy for premature rupture of membranes and preterm labor and effect on fetal outcome. Geburtshilfe Frauenheilkd 2013; 73 (12) 1218-1227
- 9 Esteves JS, de Sá RA, de Carvalho PR, Coca Velarde LG. Neonatal outcome in women with preterm premature rupture of membranes (PPROM) between 18 and 26 weeks. J Matern Fetal Neonatal Med 2016; 29 (07) 1108-1112
- 10 Azria E. Prise en charge anténatale en cas de rupture prématurée des membranes avant la viabilité fœtale. RPC Rupture prématurée des membranes avant terme CNGOF. Gynécol Obstét Fertil Sénol 2018; 46 (12) 1076-1088